2018 RAINBOW BRIDGE SURVEY

Please take a few minutes to answer these questions and return the survey either by mail or by email to:

or

Dr. Rafe H. Schindler

325 Sharon Park Drive, S.T.E. 214

Menlo Park, CA 94025

All information provided to the Health Committee will be treated confidentially. No information identifying a survey responder or a dog’s name, registration or pedigree will ever be released publicly or privately.

RAINBOW BRIDGE SURVEY QUESTIONS

1)Your Affiliation (check all that apply)

  1. HCA member. [ ]
  2. Local or Regional Havanese Club member. [ ]
  3. Other AKC breed or all-breed club member. [ ]
  4. Havanese owner without a club affiliation. [ ]

2)Your Status:

  1. Currently a breeder of Havanese? [ ]
  2. Have been a breeder of Havanese? [ ]
  3. Owner but non-breeder ofHavanese? [ ]

3)Your email address just in case we have further questions surrounding your answers to the questions below: [ optional ].

4)If you have lost one or more Havanese by natural causes (i.e. disease, old age etc.), please answer the following questions for each dog:

# / AKC Registered?
(Yes/No) / Sex
(M/F) / Approximate Age at
Death
(Years, Mo) / Primary Cause of Natural Death* / How Was Cause of Death Determined? / Age When Neutered or Spayed
IfIntact, Leave Blank / Describe Lifestyle** / Registered Name and/or Registration Number
(optional)***
1
2
3
4
5

* If it was necessary to euthanize a dog, please explain the circumstances:

forexample, dog had T-cell lymphoma, in pain and had poor quality of life.

** We want to understand the kind of environment the dog was exposed to; e.g. urban, suburban, rural, or primarily a kenneled dog. Some brief information about the dog’s lifestyle will also be helpful. For example; whether the dog lived as a pet, a kennel dog; whetherit travelled a lot or stayed primarily at home.

*** This allows us to verify the dog’s information isn’t duplicated and will be kept strictly confidential